Sarah E. Bledsoe

Implementing Evidence-Based Social Work Practice

Recently, social work has been influenced by new forms of practice that hold promise for bringing practice and research together to strengthen the scientific knowledge base supporting social work intervention. The most recent new practice framework is evidence-based practice. However, although evidence-based practice has many qualities that might attract social workers to adopt it, use in practice is limited. Accordingly, attention is being given to determine effective strategies for the dissemination, adoption, and implementation of evidence-based practice. This article examines the implementation literature, describes alternative strategies for implementation of evidence-based practice in social work, describes an implementation study to illustrate concepts discussed, and specifies needed research.

Treating Depression during Pregnancy and the Postpartum: A Preliminary Meta-Analysis.

Objectives: This meta-analysis evaluates treatment effects for nonpsychotic major depression during pregnancy and postpartum comparing interventions by type and timing. Methods: Studies for decreasing depressive severity during pregnancy and postpartum applying treatment trials and standardized measures were included. Standardized mean differences were calculated for continuous variable outcome data. Results: Thirteen interventions reported positive effect sizes, one reported marginally positive effect size, one reported no effect, and the remaining reported marginally negative effect size. By type of treatment, medication with cognitive behavioral therapy (CBT; 3.871, p < .001) and medication alone (3.048, p < .001) reported largest effect size, followed by group therapy (CBT, educational, and transactional analysis; 2.045, p < .001), interpersonal psychotherapy (1.260, p < .001), CBT (.642, p < .001), psychodynamic (.526, p = .014), counseling (.418, p = .014), and educational (.100, p = .457). Postpartum implementation produced larger effect size (.837, p < .001) than implementation during pregnancy (.377, p = .002). When medication interventions are excluded, postpartum effect size is .704 (p < .001). Conclusions: Preliminary findings suggest medication, alone or with CBT; group therapy with CBT, educational, and transactional analysis components; interpersonal psychotherapy; and CBT produce largest effect sizes in this population among interventions tested.

Preparing Social Work Practitioners to Use Evidence-Based Practice: A Comparison of Experiences From an Implementation Project

The implementation of evidence-based practice (EBP) as a professional model of practice for social work has been suggested as one approach to support informed clinical decision making. However, different barriers and processes have been identified that impact the use of EBP at individual, organizational, and systemic levels. This article describes results from a project that sought to enhance practitioner use of EBP by using a supportive strategy including training and technical assistance through a partnership between university-based researchers and three social work agencies. Results compare similarities and differences across each of the three agencies in terms of barriers and promoters at the team, organizational, and system levels. Results suggest that comprehensive multilevel interventions are needed to support the use of EBP in social work organizations and that further research is needed to test explicit partnership components. Findings suggest that a multilevel approach has the greatest potential to support implementation of EBP in social agencies.

Teaching Evidence-Based Practice

A complete and mindfully developed blueprint for implementing evidence-based practice (EBP) in social work should include a full complement of coordinated goals and strategies for all stakeholders, including future social workers. To this end, schools of social work should teach students to be lifelong learners; teach students what is currently known and not known about the efficacy and effectiveness of social work practices and programs; teach students to be knowledgeable and skillful with the empirically supported practices in their area of specialty; teach current practitioners new knowledge and skills through evidence-based continuing education programs. This article describes these strategies and draws on examples from the classroom and a pilot training project designed to support EBP in social work agencies.

AGENCY–UNIVERSITY PARTNERSHIP FOR EVIDENCE-BASED PRACTICE IN SOCIAL WORK

Little is known about evidence-based practice (EBP) in social service agencies beyond studies of researcher, practitioner, and educator opinions. The Bringing Evidence for Social Work Training (BEST) Project involved 16 participants from 3 social service agencies. The experiential training, delivered by 2 doctoral students, focused on a team-identified practice issue and followed the EBP process of motivation, question formulation, search, evaluation, and application planning. Posttraining focus group data were analyzed. Results suggest that university researchers who based in schools of social work can successfully collaborate with agencies to support the process of identifying, evaluating, and discussing the application of research evidence in practice. University–agency training partnerships should be considered as 1 of many potential strategies for advancing EBP in social work.

Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy for Antenatal Depression in an Obstetrics Clinic: A Pilot Study.

Objective: To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression, we conducted a pilot study to assess the feasibility of providing brief interpersonal psychotherapy (IPT-B) to depressed, pregnant patients on low incomes in an obstetrics and gynecological (OB/GYN) clinic. Method: Twelve pregnant, depressed women were recruited as a convenience sample from the clinic and were offered a pretreatment engagement interview and eight sessions of IPT-B, followed by monthly maintenance IPT sessions up to 6-months postpartum. Results: Nine of these 12 patients (75%) completed eight sessions of IPT-B. Paired t tests showed that completers of IPT-B displayed significant improvement at posttreatment and 6-months postpartum on three measures of depression, a measure of anxiety, and some aspects of social functioning. Conclusions: These preliminary results suggest that providing depression screening and treatment to this sample in an OB/GYN clinic was feasible and accompanied by high rates of clinical and functional improvement.

Empirically Supported Psychotherapy in Social Work Training Programs: Does the Definition of Evidence Matter?.

Objectives: A national survey finds that 62% of social work programs do not require didactic and clinical supervision in any empirically supported psychotherapy (EST). The authors report the results of analysis of national survey data using two alternative classifications of EST to determine if the results are because of the definition of EST used in the national survey. Method: Psychotherapies in the national survey are classified by three definitions of EST. Data are weighted to provide estimates generalizable to the population of social work programs. Results: The classification of EST does not have a major impact on the findings of the national survey. The national survey definition produce estimates of training in any EST in social work that fall between the two alternate definitions. Conclusions: Regardless of which definition is used, the data clearly show that the majority of social work programs offer little training in EST.

Effects of Correctional-Based Programs for Female Inmates: A Systematic Review

Objective: To examine the effectiveness of interventions for incarcerated women. Method: The researchers use a two-model system: the risk-reduction model for studies analyzing interventions to reduce recidivism rates, and the enhancement model for studies that target psychological and physical well-being. Results: Incarcerated women who participate in substance abuse interventions appear less likely to reoffend than those who do not participate. Enhancement model studies report mixed results. Overall, psychological-oriented interventions and substance abuse programs improve mental health symptoms and substance use among participants as compared to control or comparison groups. Results for HIV prevention programs are ambiguous, and parenting skill programs show no significant effect. Conclusion: Results highlight interventions that appear useful with female inmates. More rigorous research is needed to address many of these evidence-based interventions.

Depression in African American and White Women with Low Incomes: The Role of Chronic Stress

SUMMARY The current study examined the links between frequency and severity of acute and chronic stress, on the one hand, and depressive symptoms, on the other hand, in a racially balanced sample of African American and White women with low incomes. We predicted and found that severity of chronic stress accounted for more of the variance in depressive symptoms than did severity of acute stress and that severity of chronic stress amplified the effects of the severity of acute stress on depressive symptoms. Results also showed that African American women tended to have a greater number of depressive symptoms than White women, controlling for income, possibly because they experienced a greater number of chronic stressors than did White women, a condition that rendered them more vulnerable to psychological distress.

Barriers and Promoters of Mental Health Services Utilization in a Latino Context: A Literature Review and Recommendations from an Ecosystems Perspective

ABSTRACT This article focuses on the problems of disparities in mental health service utilization in the Latino population in the United States. It begins with an overview of the Latino population within the United States, an exploration of the diversity within this group, and shared cultural values and traits with a particular focus on the problems of Latino poverty. A review of the literature follows, including identified barriers to and promoters of mental health services utilization. These are contextualized in a Latino perspective using an ecosystems framework. Recommendations are made for future practice, research, and policy regarding mental health and mental health services utilization in the Latino community.